College of Medicine and Dentistry, James Cook University, Townsville, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Australia; School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Australia.
Res Social Adm Pharm. 2022 Oct;18(10):3766-3774. doi: 10.1016/j.sapharm.2022.05.002. Epub 2022 May 5.
The primary health care management of chronic disease affecting Aboriginal and Torres Strait Islander peoples requires healthcare quality and equity demands to be met, and systems that foster better team-based care. Non-dispensing pharmacists (NDPs) integrated within primary healthcare settings can enhance the quality of patient care, although factors that enable or challenge integration within these settings need to be better understood.
To investigate enabling factors and barriers influencing integration of NDPs within Aboriginal community-controlled health services delivering primary health care. This was achieved through qualitative evaluation of the Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC) Trial exploring the perceptions of NDPs, community pharmacists, healthcare staff, managers, and Aboriginal and Torres Strait Islander patients of these services.
NDPs were employed across twenty urban, rural, and remote services in three Australian states and provided pre-defined medication-related roles to adult Aboriginal and Torres Strait Islander patients. Perceptions were elicited from online surveys, interviews, and focus groups. Transcripts were thematically analyzed using the constant comparison method to identify, compare, and refine emerging themes.
One hundred and four participants informed the findings, including 24 NDPs, 13 general practitioners, 12 service managers, 10 community pharmacists, 17 health service staff, and 17 patients. Enablers of integration included: personal (previous experience with Aboriginal and Torres Strait Islander peoples, cultural awareness, skills, individual attributes); health service-related (induction programs, Aboriginal Health Worker support, team-building initiatives); and community-related factors (engaged community elders, leaders, cultural mentors, community pharmacy champions). Barriers to NDP integration included a lack of systems supports for patients and staff to adapt to NDP roles, health service factors, travel requirements, a lack of community linkages, and time and budget constraints.
NDP integration within primary health care services has potential to enhance medication-related services to Aboriginal and Torres Strait Islander peoples if enabling factors are supported and health systems and adequate resources facilitate the integration of pharmacists within these settings.
影响原住民和托雷斯海峡岛民的慢性病的初级卫生保健管理需要满足医疗质量和平等要求，并建立促进更好的团队式护理的系统。在初级卫生保健环境中整合非配药药剂师（NDP）可以提高患者护理质量，但需要更好地了解在这些环境中促进或挑战整合的因素。
调查影响 NDP 在提供初级卫生保健的原住民社区控制的卫生服务中整合的有利因素和障碍。这是通过对整合药剂师在原住民社区控制的卫生服务中（IPAC）试验的定性评估来实现的，该试验探讨了 NDP、社区药剂师、医疗保健人员、管理人员以及原住民和托雷斯海峡岛民患者对这些服务的看法。
在澳大利亚三个州的 20 个城市、农村和偏远地区的服务中雇用了 NDP，并向成年原住民和托雷斯海峡岛民患者提供预先定义的药物相关角色。通过在线调查、访谈和焦点小组收集意见。使用恒定比较法对转录本进行主题分析，以识别、比较和完善新出现的主题。
共有 104 名参与者提供了调查结果，包括 24 名 NDP、13 名全科医生、12 名服务经理、10 名社区药剂师、17 名卫生服务人员和 17 名患者。整合的促进因素包括：个人（以前与原住民和托雷斯海峡岛民交往的经验、文化意识、技能、个人属性）；与卫生服务相关的因素（入职培训计划、原住民卫生工作者支持、团队建设举措）；以及社区相关因素（参与的社区长辈、领导、文化导师、社区药房拥护者）。NDP 整合的障碍包括缺乏支持患者和员工适应 NDP 角色的系统支持、卫生服务因素、旅行要求、缺乏社区联系以及时间和预算限制。
如果支持有利因素并且卫生系统和充足的资源促进药剂师在这些环境中的整合，那么在初级卫生保健服务中整合 NDP 有可能改善对原住民和托雷斯海峡岛民的药物相关服务。
